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The psychiatric diagnostic manual (DSM) which psychiatrists and other mental health care professionals refer to, classifies and names mental health conditions.  For example, a patient who displays six out of nine symptoms from two subsets of symptoms related to inattention and hyperactivity/impulsivity will receive the diagnosis of ADHD or attention deficit/hyperactivity disorder.  And with the diagnosis comes a 'treatment.' Not only is the term for this 'disorder' disparaging it is also grossly inaccurate.  I have had a number of patients sit in front of me and  cry when I have had to say, yes, according to the DSM IV (latest edition), you have a mental health condition and it's called ADHD. 

The term for this 'condition' has actually come a long way since the early 1900s when the term 'Defect of Moral Control' was used. After that it evolved into 'Post-Encephalitic Behavior Disorder' and then in the 1960's to 'Minimal Brain Dysfunction.' In the term ADHD there is 'deficit' and 'disorder'. It's also been referred to as a disease and an illness among other things.  It's no wonder there is such a negative stigma that accompanies the term. And no wonder why so many newly diagnosed cry as if receiving a life sentence.  Given that more than 4.5 % of the adult population could fulfill the criteria for ADHD, that's a hell of a lot of tears and life sentences!

But what is ADHD? It's an imbalance of catecholamine metabolism in the cerebral cortex (thereby affecting higher cortical functions) and an imbalance between the norepinephrine and dopamine systems in the prefrontal cortex. There is no true deficit of anything. ADHDers CAN pay attention and often times pay way more attention to something than a non ADHDer. There are pros and cons to this. The pro is that when something does catch the attention of an ADHDer, their attention can be lazer-like and interminable. On the other hand, if something does not catch their attention but should (like paying taxes) it can be unintentionally easily forgotten.  Is this a disorder? a condition? Or is it simply another expression of our neuro-diversity that is challenged in today's world where paying taxes, sitting for most of the day and filling out forms with deadlines is what's expected?

Excuse me, I just saw a lion go by-gotta run!

ADHD in the Workplace

ADHD in the Workplace is a very important topic for adults with ADHD since most adults with ADHD are working or seeking work. It is well known that those with ADHD often are under-educated relative to their intellectual ability and under-employed in their occupations relative to their intelligence. They tend to get fired and change jobs more often than others do because of issues like boredom, work performance, and/or interpersonal problems at home that interfere with work or interpersonal problems with others at work. These employment issues can lead to increased family stress and loss of health and retirement benefits. In fact, there is a huge financial burden that accompanies ADHD. Individuals with ADHD on average earn approximately $8,000/yr less than those without ADHD. This translates into about $77 billion in combined lost income each year once the loss per individual is multiplied by the number of individuals with ADHD.

What are some of the potential problems at work? Time management and procrastination issues may lead to missed deadlines. Organizational issues may lead to lost work. Impulsivity may strain interpersonal relations. Difficulties sitting still that may make completing assignments more challenging. Difficultly with attending to details, managing long-term projects, and boredom may result in suboptimal work. These troubles at work can easily lead to depression, anxiety, panic and insomnia- symptoms that individuals often seek medical attention for. It is critical that your primary care or mental health provider recognizes that these symptoms may be secondary to the primary problem of ADHD and that treatment must be for the ADHD and not just for the secondary symptoms. If your provider treats only the secondary symptoms with anxiolytics, antidepressants, tranquilizers and hypnotics without addressing the core ADHD issues, treatment will probably not be effective.

How can ADHDers overcome problems at work? Individuals with ADHD are protected at work under the American with Disabilities Act of 1990 however being diagnosed with ADHD does not automatically make someone eligible for protection or accommodations. In order to be eligible for protection under the Act, an employee must disclose their disability to the employer. However many individuals with ADHD are hesitant to disclose their ADHD to their employer since this disclosure can be a double edged sword. While on one hand the disclosure can provide legal protection, some worry that disclosure on the other hand may lead to discrimination because their employers may be skeptical that the condition even exists and have no idea about the various symptoms associated with ADHD and how debilitating these symptoms can be.

One thing people with ADHD can do in order to obtain accommodations at work without disclosing their diagnosis is to ask their employer for certain accommodations based on "a medical condition" without revealing to the employer the ADHD diagnosis. If you choose to ask your employer for medical accommodations, you should ask the doctor that treats your ADHD to write a letter to your employer supporting your request for these accommodations. This letter, as above, does not need to include any mention of your diagnosis. I have written many such letters for patients in my practice and they have found this to be very helpful. 

Another thing people with ADHD can do to maximize work performance is to hire an ADHD coach. Coaches can be helpful to those with ADHD by offering useful tools to get through the work day more efficiently and effectively. You can find a coach by checking www.adhdcoaches.org which is the professional membership organization for ADHD coaches. Another option is to find a professional career counselor with experience in ADHD. This counselor, once they get to know you, can assist you in finding a suitable careers where your strengths are maximized and your weaknesses are minimized. These counselors can be located through resources such as www.chadd.org- the National Organization for Children and Adults with ADHD and www.help4adhd.org: the National Resource Center on ADHD.

If you would like to read and learn more about how the symptoms of ADHD lead to impairments at work I recommend reading a landmark book entitled  “ADHD in Adults: What the Science Says” by Russell Barkley PhD, a leading researcher on ADHD. Dr. Barkely reviews in this book groundbreaking scientific information stemming from the results of two major research investigations that shed light upon the significant impairments caused by symptoms of ADHD across major life activities such as work and relationships.

Other good books on this topic include:

Wilma Fellman “Finding A Career That Works For You: A Step-by-Step Guide to Choosing a Career” 

Kathleen Nadeau “ADD In The Workplace: Choices, Changes, And Challenges”
Lynn Weiss “ADD on the Job: Making Your ADD Work For You”

Other websites to consider include: 

www.askjan.org: The Job Accommodation Network provides information about job accommodations, the Americans with Disabilities Act

www.dol.gov/odep: The United States Department of Labor Office of Disability and Employment Policy

www.askearn.org: Resources to help employers hire and retain people with disabilities

www.careeronestop.org: Tools to help job seekers, students, businesses and career professionals sponsored by the U.S. Department of Labor

Wendy Woodard PsyD and I will be co-moderating our next Adult ADHD support group (free) on this very topic on Monday, June 6, 2011 from 6-7 PM at Seattle Healing Arts Center. In the meantime, what are your thoughts on how ADHD effects us in the workplace and how we can make our ADHD work in our favor in the workplace? Please use the comment form below and let me know. Hope to see you at the next group!

Stimulant Shortage: Conspiracy, Honest Errors or Over-Demand?

About 5.4 million children ages 4 to 17 have been diagnosed with ADHD; 66% take medications to control their symptoms. In addition, there are nearly 8 million adults diagnosed with ADHD the majority of whom take medications. Last year, that amounted to 152 million units sold of Adderall and Adderall XR, the extended-release version of the pill, 35 million units of Ritalin and nearly 702 million units of generic ADHD drugs with sales totaling more than $1.2 billion. The drugs are usually taken daily to control distracted thoughts and behavior well enough to participate in school, work and social life.

In early April, the U.S. Food and Drug Administration (FDA) added two major ADHD medications to its list of current drug shortages. The Pacific Northwest has been hit hard by these shortages due to a limited supply of the ʻactive pharmaceutical ingredientʼ (API) used to make brand medications such as Adderall XR, generically an Amphetamine Mixed Salt, and Metadate, a brand version of the generic Methylphenidate. The U.S. Drug Enforcement Administration (DEA) imposes quotas of this active ingredient on the manufactures. Why? There is potential for abuse especially among college students.

These current shortages have sparked a round of finger-pointing between Shire PLC the manufacturer and the DEA. Shire blames the shortage of branded and generic versions of its Adderall XR on DEA limits on the amount of product Shire can manufacture. The DEA, however, is deflecting the blame and issued this statement: “Manufacturers can request additional quota at any time during the year. DEA will review their request and provide additional quota, if warranted.” Adderall generated $361 million in sales for Shire in 2010, down 42% from 2009 because of the availability of cheap generic versions of the drug. Shire also supplies generic versions of Adderall that are marketed by Teva Pharmaceutical Industries Ltd. and Impax Laboratories Inc. UCB SA, a maker of generic methylphenidate, attributed its shortages to increased customer demand earlier this year.

Patients and pharmacies are having difficulty getting access to generic versions of ADHD drugs, forcing many patients to switch to more expensive branded drugs, switch to immediate release formulations, stretch their drug supply or take no drug at all. Brand-name drugs can exceed $200 a month if health plans cover only generics. While the FDA reports shortages like generic XR because of limited API put out by the DEA, ADHDers console yourselves by eating some alphabet soup. And stock up, because the end is no where in sight.

What to do? Here's some advice from Timothy MacGeorge, MDiv, MSW director of the National Resource Center on ADHD who posted the following information on the CHADD Leadership blog:

If you experience difficulty in filling an ADHD prescription due to this shortage, here’s what you can do:

• Ask your pharmacist if the medication is available from another location, especially if you use a large chain pharmacy.
• Contact the manufacturer to help locate a pharmacy that has your medication in stock (see the customer service numbers below). 
• Contact the doctor who prescribed the medication to see if he/she has any samples you can use. 
• Ask your pharmacist about the availability of other medications used to treat ADHD. 
• As a last resort, discuss with your prescribing physician whether or not any of these available medications might be appropriate for you or your child. 

Pharmaceutical companies that produce Amphetamine Mixed Salts ER Capsules: 

• Shire Customer Service Number: 800-828-2088 (select “Option 5” for assistance in locating a pharmacy in your area with product availability) 
• Teva Customer Service: 888-838-2872 
• Global Customer Service: 215-558-4300

Pharmaceutical companies that produce Methylphenidate HCL: 

• UCB Customer Service: 800-477-7877 
• Covidien Customer Service: 800-325-8888 
• Sandoz Customer Service: 609-627-8500 
• Watson Customer Service: 973-355-8300

As usual, I would love to hear  your comments, questions or suggestions so please use the form below to submit those. Next week's topic will be ADHD in the Workplace. Hope to see you then!

Welcome to my Blog- Support Groups

Welcome! This is my first blog entry for a new blog on adult Attention Deficit Hyperactivity Disorder (ADHD). I write this blog as a person with ADHD, as a parent of a teen-aged son with ADHD, oppositional defiant disorder and depression and as an Internal Medicine physician who treats and counsels adults with ADHD. Although there are many blogs addressing ADHD, most of them are written by lay people who may or may not live with ADHD, may not be raising children with this condition and who are not treating patients. In my blog I will review current scientific developments on ADHD and report other useful information that I gain from my own personal experience and from my patients, colleagues and attendees of my monthly adult ADHD support group meetings that I will tell you more about below. But first I would like to share a little bit about myself. 

As is typical, I was diagnosed with ADHD in my early 40ʼs shortly after my son who was seven at the time, was diagnosed with ADHD. I couldnʼt believe that I had gone through medical school and Internal Medicine/Primary Care Residency training without a notion of adult ADHD (ADHD was originally believed to be mainly a pediatric condition). I learned more about ADHD and its highly genetic transmissibility. I became aware that my life long struggles were also ones he was beginning to experience. And so began my journey thanks to my son, that leads me here today writing this blog. I'll share my thoughts on various aspects of life with ADHD through personal as well as professional insights.

Besides telling you about myself in this first post, I would also like to tell you about ADHD support groups. Support groups can be very useful for adults with ADHD; one does not feel so alone when meeting others struggling with many of the same issues. Attendees can learn from each other and be a source of information for local resources to other members of the group. My support group is run under the auspices of our local Seattle CHADD chapter. CHADD stands for CHildren and adults with Attention Deficit Disorder. CHADD is a national organization providing education, advocacy and support for those with ADHD. The Seattle chapter falls under the Northwest Chapter of CHADD. CHADD has other local support groups that you can learn about by by visiting the Northwest Chapter website.  ADD Resources is another organization located in Tacoma, WA and has local support groups for both parents of children with ADHD and adults with ADHD. Anyone is free to join my support group which meets the first Monday of every month at 6 PM on the second floor of Seattle Healing Arts (map/directions), which is where my practice is located. There is no charge for attending the group and sessions last for about an hour. Snacks and beverages are welcome. Next meeting is on June 6th; discussion to include the impact of ADHD in the workplace and on friendships. Dr. Wendy Woodard Psy.D.,ABDA will be co-moderating with me.

Check my blog if you think this kind of information may be of interest to you. You can post a comment- we all have something to contribute to this discussion! Please note that in an effort to avoid posts that are promotional or outright span, my blog is moderated which means I will have to approve comments before they are publicly available and this may take up to 24hrs. My next post is scheduled for 5/23/11 and will most likely address the national mixed amphetamine salt shortage. Thanks for stopping by!